Fasting and Nonfasting Apolipoprotein B-100 and Apolipoprotein A-I and Risk of Ischemic Heart Disease and Total Mortality

A follow-on to the 2008 fasting study from the same Copenhagen group, this paper focused specifically on apolipoprotein B-100 and apolipoprotein A-I — the protein markers of atherogenic and protective lipoproteins — and asked whether fasting status affected their ability to predict ischemic heart disease and all-cause mortality.

In 58,000 Copenhagen residents, nonfasting apoB and ApoA-I concentrations were essentially identical to fasting values, and their predictive power for IHD and all-cause mortality was equivalent regardless of whether patients were fasted or not.

The clinical implications build directly on the 2008 findings. ApoB and ApoA-I are already superior to LDL and HDL cholesterol for cardiovascular risk prediction. If they can be measured accurately nonfasting — with no loss of predictive power — the case for apolipoprotein-based testing over the standard fasting lipid panel becomes considerably stronger: better markers, measured more conveniently, with no clinical tradeoff.

We rate the evidence strong, with very high clinical significance. One of the largest studies confirming the equivalence of fasting and nonfasting apolipoprotein measurement for cardiovascular risk prediction — a direct, practical argument for simplified, accessible lipid testing in clinical practice.